Influence of pituitary suppression with triphasic or monophasic oral contraceptives on the outcome of in vitro fertilization and embryo transfer

Purpose: To compare the clinical outcome of IVF treatment after pituitary suppression with two different oral contraceptives (OCs). Methods: 65 patients who received IVF treatment was classified into 2 groups based on the difference of OCs they used for pituitary suppression before ovarian hyperstimulation. Group 1 included 36 patients who received monophasic OCs. Group 2 included 29 patients who received triphastic OCs. Both groups received the OCs from the 5th day of the cycle for consecutive 21 days. The hormone profiles after OCs and clinical outcome of IVF treatment were compared between two groups. Two-sample t-tests and X2 tests were used for statistical analyses. P < 0.05 was considered statistically significant. Results: The mean age and basal hormone profiles were comparable between two groups. After ovulation suppression with different OCs, the day 2 FSH and LH value revealed statistically significant difference between two groups(4.2±1.8 vs 6.0±2.6; 2.7±2.0 vs 4.2±3.3 respectively). The numbers of oocyte per retrieval and fertilization rate were comparable between two groups, but higher quality embryos as revealed by the cleavage speed were noted in the triphastic OCs group. Although statistically not significant, higher implantation rate and pregnancy rate were also noted in the triphastic OCs group. Conclusions: Different OCs for pituitary suppression can result in different hormone profiles. Ovulation induction in IVF treatment should be individualized according to these hormone changes to achieve the optimal clinical outcome. Triphastic OCs exceeds monophastic OCs in producing good quality embryo in IVF-ET treatment.     

Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH agonist protocols for in vitro fertilization in PCOS non-obese patients. A prospective randomized study

Purpose  Embryological and clinical efficacy of gonadotropin-releasing hormone (GnRH) antagonist and agonist stimulation protocols in non-obese women with polycystic ovarian syndrome (PCOS) were compared. Methods  A prospective randomized study. Setting: Medical University Hospital. Patients: 70 infertile PCOS patients; 33 in GnRH antagonist and 37 in GnRH agonist group. Results  Similar mature metaphase II oocyte rate (76% vs. 76%) was observed in both protocols. Optimal pronuclear morphology zygotes dominated in both groups (64% vs. 66%). Transferred embryo quality did not differ in both protocols. No significant differences between both protocols were found in delivery rate (p = 0.481), pregnancy rate (p = 0.810), multiple pregnancy rate (p = 0.501), miscarriage rate (p = 0.154), fertilization rate (p = 0.388) and implantation rate (p = 1.000). Duration of stimulation and total follicle-stimulating hormone (FSH) dose were significantly lower in GnRH antagonist protocol (p = 0.0005). Conclusions  GnRH antagonist and agonist protocols in non-obese PCOS patients yield similar embryological and clinical outcomes. Shorter duration of treatment and lower FSH requirement in GnRH antagonist group may be financially beneficial and therefore attractive for patients. Capsule GnRH antagonist and agonist protocols in non-obese PCOS patients yield similar embryological and clinical outcomes. GnRH antagonist protocols may be financially and clinically attractive for patients undergoing IVF.     

The impact of the depth of embryo replacement on IVF outcome

Purpose: To evaluate the effect of the depth of embryo transfer replacement on clinical pregnancy rate. Methods: Data from a total of 104 consecutive embryo transfers performed on 104 womenn aged 26–37 years were prospectively collected for this study. All patients underwent a standard down regulation protocol for ovarian stimulation. Oocytes retrieval were performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups according to the distance between the tip of the catheter and the uterine fundus at transfer (group A > 10 < 15 mm and group B ≤ 10 mm). The same method of loading embryos into the embryo transfer catheter was used. Results: Clinical pregnancy rates varied significantly (p ≤ 0.05) between the two groups: 27.7% in group A and 14% in group B. The number and quality of embryos transferred did not differ between the groups. Conclusions: The results suggest that the depth of embryo replacement may be an important variable in embryo transfer technique.     

Comparison of embryo quality between intracytoplasmic sperm injection and in vitro fertilization in sibling oocytes

Background The aim of the present study was to compare the quality of embryos derived from sibling oocytes by in vitro fertilization (IVF) or ICSI. Methods Consecutive patients with a less than 40% fertilization rate in a previous standard IVF cycle or with relative male factor infertility were recruited for the study. The oocytes retrieved from each patient were divided into two groups for either conventional insemination (group A) or ICSI (group B). Power analysis showed that to detect a 25% difference in the rate of high-quality embryos between the groups with a power of 0.8, at least 1,200 oocytes were needed in each group. Results One hundred seventy-seven patients were included in the study. Group A was comprised of 1,526 oocytes and group B of 1,480 sibling oocytes. As expected, the fertilization rate was significantly higher in group B than group A (67.1 vs. 43.6%, p < 0.001). No significant between-group differences were observed in cleavage rate (92.7 and 89.7%, respectively) and the rate of either grade A embryos (22.6 and 23.9%, respectively) or grade A₁ embryos (37.3 and 33.5%, respectively). However, in the subgroup of patients with relative male-factor infertility (n = 36), the rate of grade A₁ embryos was significantly higher in the IVF than the ICSI group (46.4 vs. 29.0%, respectively, p = 0.02). Conclusions Embryo quality does not seem to be influenced by the mode of fertilization (IVF or ICSI). We assume that embryo quality depends on intrinsic factors of the gametes involved rather than on the fertilization process per se. Capsule Embryo quality does not seem to be influenced by the mode of fertilization but depends on intrinsic factors of the gametes involved.     

Effects of triploidy incidence on clinical outcomes for IVF-ET cycles in different ovarian stimulation protocols

Abstract

Purpose: To discuss the relationship between triploidy incidence and clinical outcomes of embryos derived from normally fertilized oocytes from the same cohort for in vitro fertilization-embryo transfer (IVF-ET) cycles in different ovarian stimulation protocol.

Methods: This study included 2070 in vitro fertilization (IVF) cycles with long-term protocol, 802 IVF cycles with ultra short-term protocol and 508 IVF-D (in vitro fertilization by donor semen) cycles with long-term protocol from January 2013 to September 2014. According to the different 3PN rate, patients were divided into three groups as follows: Group 1 included patients with 0% 3PN zygotes, Group 2 included patients with 1–25% 3PN zygotes and Group 3 included patients with >25% 3PN zygotes. Main outcome measure: female age, no. of retrieved oocytes, normal fertilization rate, day-3 grade I?+?II embryos rate, day-3 grade I?+?II?+?III embryos rate, implantation rate, pregnancy rate and early abortion rate.

Results: Triploidy cycle incidence rate in IVF and IVF-D cycles with long-term protocol were significantly higher than in IVF cycles with ultra short-term protocol (p?<?0.001). Triploidy fertilization rate found no significant difference between the three groups (p?>?0.05). In three protocols, normal fertilization rate in 3PN?=?0% and 3PN?=?1–25% groups were significantly higher compared to 3PN?>?25% group (p?<?0.001). In IVF cycles with long-term protocol, the day-3 grade I?+?II embryos, implantation and pregnancy rate in 3PN?>?25% group were significantly lower than other two groups (p?<?0.05). The day-3 grade I?+?II?+?III embryos and early abortion rate found no significant difference between the three groups (p?>?0.05). In IVF cycles with ultra short-term protocol, there were no significant differences found in day-3 grade I?+?II embryos, day-3 grade I?+?II?+?III embryos, implantation, pregnancy and early abortion rate (p?>?0.05). In IVF-D cycles with long-term protocol, the day-3 grade I?+?II embryos, day-3 grade I?+?II?+?III embryos and implantation rate in 3PN?>?25% group were significantly lower than other two groups (p?<?0.05). The pregnancy and early abortion rates found no significant difference in the three groups (p?>?0.05).

Conclusion: We observed that high proportion of triploid zygotes made a negative effect on clinical outcomes for IVF-ET cycles with long-term protocol.     

“Chromohysteroscopy” for evaluation of endometrium in recurrent in vitro fertilization failure

Purpose To assess the efficacy of chromohysteroscopy in detecting endometrial pathologies in recurrent in vitro fertilization (IVF) failure. Materials and methods Sixty-four patients in whom conventional hysteroscopy did not show any apparent endometrial pathology were included. Five milliliter of 1% methylene blue dye was introduced through the hysteroscopic inlet. Biopsies were obtained both from dark stained and light stained areas. Results The study group was grouped according to the staining characteristics. Group I included 22 patients in whom focal dark staining was observed. Group II included 41 patients in whom diffuse light blue staining without dark areas was observed. There was no significant difference between two groups in age, smoking, body mass index, number of IVF failure and time to hysteroscopy after the last failure. But, there was a statistically significant difference in the incidence of endometritis between two groups (p = 0.007). The power of dark staining for detection of endometritis was calculated as follows: sensitivity 69.2%, specificity 74%, positive predictive value 40.9% and negative predictive value 90.2%. Conclusion Chromohysteroscopy improves the efficacy of hysteroscopy in recurrent IVF failure. Observation of diffuse light blue staining without dark areas strongly suggests a normal endometrium free of endometritis. Capsule Chromohysteroscopy improves the efficacy of hysteroscopy in recurrent IVF failure.     

Previous tubal ectopic pregnancy raises the incidence of repeated ectopic pregnancies in In Vitro fertilization-embryo transfer patients

Purpose  To investigate the incidence of Tubal Ectopic Pregnancies (TEP) in IVF-ET patients with respect to the status of the fallopian tubes after a previous TEP. Material and methods  This retrospective study compares patients undergoing 481 IVF-ET cycles after conservatively or surgically treated TEP(s) with a Control Group (idiopathic or male factor for IVF-ET indication). Medical reports of surgery and/or hysterosalpingograms prior to the IVF cycles classified the status of the fallopian tubes. Results  12 TEPs (8.95%/Pregnancies (PR)) occurred in the Study Group. In the Control Group one TEP (0.75%/PR; p < 0.001) was found. Smoking increased the probability of TEPs (p = 0.0028) and of pathological pregnancies (abortion, biochemical and ectopic PR; (p = 0.0411)). For statistic evolution logistic regression (PROC GENMOD) and a repeated measure model were applied. Conclusion  Women with a previous TEP should be informed about the significantly increased risk for a further TEP in IVF-ET treatment, especially if they are smoking. Capsule Tubes after a Tubal ectopic pregnancy (TEP) and smoking lead to a significant higher number of repeated TEPs in following IVF-ET programs.     

Predictive value of preimplantation genetic diagnosis for aneuploidy screening in repeated IVF-ET cycles among women with recurrent implantation failure

Objective To determine the predictive value of euploid embryos in women with recurrent implantation failure undergoing repeated IVF-ET cycles with PGD (PGD). Design Cohort of IVF-PGD cycles in a tertiary care ART facility. Materials and method(s) Fifty-five consecutive patients with repeated implantation failure (more than three failed IVF-ET cycles) underwent two or more PGD cycles for aneuploidy testing. Mean maternal age was 37.6 ± 5.3 years. Biopsies were performed on day 3. One blastomere was removed from each pre-embryo, fixed and analyzed by multicolor and multi-probe FISH for chromosomes X and Y, 13, 15, 16, 17, 18, 21, and 22. Result(s) Forty-three of 55 patients (78%) undergoing PGD had at least one euploid embryo for transfer. Of these 31 patients (72%) also had at least one euploid embryo available for transfer with the second cycle. Of the 12 (28%) patients with no euploid embryos available for transfer with the second IVF/PGD cycle, five had a third cycle of PGD and two of these had euploid embryos available for transfer. Seventeen of the 31 patients (55%) who had euploid embryos on the second PGD cycle conceived. The ongoing pregnancy and implantation rates in patients with at least one euploid embryo were 40% and 18%, respectively. Twelve of the 55 patients (22%) had no euploid embryos available for transfer on the first PGD cycle, but on the second PGD cycle, six (50%) of these had euploid embryos for transfer. Only two pregnancies were achieved among this group of women, yielding a pregnancy rate of 17%, but both conceptions resulted in miscarriage. Of the six patients with no euploid embryos available after the second PGD cycle, four patients had a third IVF/PGD cycle, but none had euploid embryos available for transfer. Also, among women with euploid embryos available only in either the first or second PGD cycle, but not both, no ongoing pregnancy was achieved. No woman who had a PGD cycle productive of no euploid embryos had an ongoing pregnancy. Significant differences were found in terms of ongoing pregnancy (40%, P < 0.05) and implantation rates (18%, P < 0.05) in women with euploid embryos available for transfer with the first and second IVF/PGD cycles, compared to women with no euploid embryos available for transfer with either the first or second cycle. The positive predictive value of the first euploid cycle predicting a second euploid cycle was 72%, 95% CI 0.66–0.78. The negative predictive value of an aneuploid cycle was 50%, 95% CI 0.27–0.72. The sensitivity and specificity of the first PGD cycle predicting the second was 84%, 95% CI 0.77–0.91 and 33%, 95% CI 0.18–0.48, respectively. Conclusion(s) Even with a history of recurrent implantation failure, the availability of euploid embryos, especially on two, consecutive PGD cycles is associated with high ongoing pregnancy and implantation rates. Conversely, the absence of euploid embryos for transfer predicts poor reproductive outcome, even if subsequent cycles do yield euploid embryos.     

Sperm chromatin stability and its relationship with fertilization rate after Intracytoplasmic Sperm Injection (ICSI) in an assisted reproduction program

Objective Evaluate sperm chromatin stability and its relationship with the rate of fertilization after procedures of intracytoplasmic sperm injection (ICSI) in a program of assisted reproduction. Design Prospective study. Setting Institute of Gynecology and Reproduction. Patients Thirty-three women with their respective partners (12 couples in the study group and 21 couples in the control group) participating in a program of assisted reproduction. The study group was defined as men with >30% of non-decondensed spermatozoa (high sperm chromatin stability). Interventions A part of each seminal sample was used to evaluate sperm chromatin stability under SDS and EDTA treatment and the second aliquot was used for the ICSI procedure. Fertilization was evaluated 16–18 h post sperm injection at a pronuclear stage. The fertilized oocytes were further cultured for 24–48 h before transfer to the patient. Main outcome measures Fertilization rate. Results Thirty-five oocytes (35.7%) in the group of study and 109 oocytes (78.9%) in the control group showed two pronuclei (P < 0.001). The coefficient of determination between the SDS + EDTA (Grade 2) and rate of fertilization was r ² = 0.85 (P < 0.001) and the coefficient of regression was 1.72 ± 0.19 (β ± ES) (P < 0.001). Conclusions High sperm chromatin stability is a factor which reduces the rate of fertilization after ICSI procedure.     

Low grade inflammation, as evidenced by basal high sensitivity CRP, is not correlated to outcome measures in IVF

Purpose  To assess the relationship between low-grade inflammation, measured as basal high sensitivity (hs)-CRP, and IVF outcome. Methods  We recruited a total of 220 women undergoing infertility work up prior to IVF. Patients were selected for a BMI < 30 kg/m² with an upper age limit of 40 years. Serum hs-CRP levels were measured on day 3 of a spontaneous menstrual cycle preceding ovarian stimulation. A sensitive two-site ELISA was used for analysis. Dose of gonadotrophins required, follicles days 8 and 10, number of oocytes collected, number of oocytes fertilised and pregnancy outcome were recorded. Results  Median hs-CRP was 1.08 mg/L (0.43–3.00 mg/L). The hs-CRP was significantly related to BMI (r = 0.386, P < .001) but not to age and smoking habit. There were no significant relationships between basal hs-CRP and any of the measured IVF outcomes. Conclusions  These findings demonstrate that serum hs-CRP concentration is not a predictive marker of cycle or pregnancy outcome in women undergoing IVF treatment. Capsule   Basal low-grade inflammation does not predict IVF success as shown by the lack of correlation between day 3 hs-CRP and IVF outcome measures.     

Growth hormone co-treatment within a GnRH agonist long protocol in patients with poor ovarian response: a prospective,randomized, clinical trial

Objective The efficacy of growth hormone co-stimulation to long luteal GnRHa regimen in poor responders to COH for IVF was assessed. Methods This prospective, randomized, clinical trial was performed in a private assisted reproduction center. The study involved 61 patients who responded poorly to high dose gonadotropin treatment in their first cycles in the same center. Study group of 31 patients were given growth hormone co-treatment, daily subcutaneous injection of 4 mg from day 21 of preceding cycle along with GnRHa, until the day of hCG. Control group of 30 patients received the same treatment protocol except the growth hormone co-treatment. Primary end-point of the study was the number of oocytes fertilized whereas the pregnancy rate was the secondary end-point. Results Patients’ demographic characteristics did not differ significantly between the two groups. 2PNs in growth hormone co-treatment group was significantly higher than the control group (4.4 ± 1.8 vs 1.5 ± 0.9, p < 0.001). Although more pregnancies and more clinical pregnancies with fetal heart beat were achieved in growth hormone group (12/31), compared to the control group (6/30), the difference did not reach to statistical significance. Conclusion Poor responder women undergoing repeated assisted reproduction treatment and co-stimulated with GH achieve more oocytes, higher fertilization rate if growth hormone started in the luteal phase of previous cycle, as compared with women of the same status treated with GnRHa long protocol. The study was unable to show that clinical pregnancy rate was increased significantly.     

Chemical zona pellucida thinning with acidified Tyrode’s solution: comparison between partial and circumferential techniques

Purpose To compare effectiveness of two different chemical zona thinning techniques. Method We studied 163 patients who had experienced IVF or ICSI failures in two or more cycles. Patients were assigned to one of three groups: zona intact (n = 72), partial thinning (n = 59), or circumferential thinning (n = 73). Before transfer, the zonae pellucidae of embryos were thinned partially or circumferentially using acidified Tyrode’s solution. Results Implantation rates were 8.9% in the intact zona group, 17.6% in the partial thinning group, and 11.9% in the circumferential thinning group: respective clinical pregnancy rates were 16.7% (12/72), 32.2% (19/59), and 27.4% (20/73). Both rates were significantly higher in the partial thinning group than the intact zona group. For circumferential thinning versus zona intact groups, differences fell short of significance. Conclusions Following embryo transfer failure, partial thinning would be recommended over circumferential thinning for successful assisted hatching. In patients with previous failure of embryo transfer, partial zona pellucida thinning for assisted hatching improved implantation and clinical pregnancy rates.     

Live births after oocyte in vitro maturation with a prematuration step in women with polycystic ovary syndrome

Standard oocyte in vitro maturation (IVM) usually results in lower pregnancy rates than in vitro fertilization (IVF). IVM preceded by a prematuration step improves the acquisition of oocyte developmental competence and can enhance embryo quality (EQ). This study evaluated the effectiveness of a biphasic culture system incorporating prematuration and IVM steps (CAPA-IVM) versus standard IVM in women with polycystic ovarian morphology (PCOM). Eighty women (age < 38 years, ≥ 25 follicles of 2–9 mm in both ovaries, no major uterine abnormalities) were randomized to undergo CAPA-IVM (n = 40) or standard IVM (n = 40). CAPA-IVM uses two steps: a 24-h prematuration step with C-type natriuretic peptide-supplemented medium, then 30 h of culture in IVM media supplemented with follicle-stimulating hormone and amphiregulin. Standard IVM was performed using routine protocols. A significantly higher proportion of oocytes reached metaphase II at 30 h after CAPA-IVM versus standard IVM (63.6 vs 49.0; p < 0.001) and the number of good quality embryos per cumulus-oocyte complex tended to be higher (18.9 vs 12.7; p = 0.11). Clinical pregnancy rate per embryo transfer was 63.2% in the CAPA-IVM versus 38.5% in the standard IVM group (p = 0.04). Live birth rate per embryo transfer was not statistically different between the CAPA-IVM and standard IVM groups (50.0 vs 33.3% [p = 0.17]). No malformations were reported and birth weight was similar in the two treatment groups. Use of the CAPA-IVM system significantly improved maturation and clinical pregnancy rates versus standard IVM in patients with PCOM. Furthermore, live births after CAPA-IVM are reported for the first time.     

Interval double transfer improves treatment success in patients with repeated IVF/ET failures

Purpose  To examine whether double transfer of embryos on day 2–3 and on day 5 after ovum pick-up (OPU) improves IVF/ET success rates in patients with multiple consecutive IVF failures Methods  Consecutive IVF failures patients (7.6 ± 0.5) undergoing IVF/ET cycles were treated with interval double transfer on day 2–3 and on day 5 after OPU. Matched patients, that had embryos transferred only once on day 2 or 3 served as controls. Results  Baseline and cycle characteristics were similar in the study group and controls. The total pregnancy rate was 44.6% in the study group and 24.2% in the controls (p = 0.001), and the clinical pregnancy rates were 38.5% and 19.6%, respectively (p = 0.001). Conclusions  Patients with multiple consecutive IVF/ET failures, treated with the interval double transfer approach had significantly improved cycle success rates compared with regular day 2 or 3 embryo transfer protocol. Capsule Patients with consecutive repeated IVF/ET failures, treated with the interval double transfer had significantly improved cycle success rates compared with regular day 3 embryo transfer.     

Power Doppler ultrasound assessment of follicular vascularity in the early follicular phase and its relationship with outcome of in vitro fertilization

Objective : To determine whether ovarian perifollicular blood flow (PFBF) in the early follicular phase (EFP) was associated with treatment outcome. Design : Retrospective longitudinal cohort study. Setting : Tertiary referral centre/university hospital. Patients : Thirty-four women underwent 37 IVF cycles, which resulted in 35 embryo transfers. Interventions : Serial transvaginal scans using power Doppler ultrasound during the follicular phase. Ovarian PFBF of follicles ≥5 mm was subjectively assessed using a modified grading system (grades 0–4). Main outcome measures : Ovarian PFBF and pregnancy. Results : Treatment cycles were retrospectively divided into two groups: Group 1 (n=20) had cycles with at least one small (5–10 mm) or medium (11–14 mm) size follicle(s) of high grade (2–4) PFBF on cycle day 5 or 6 or 7; and Group 2 (n=17), had cycles that did not. Group 1 had a significantly higher proportion of high grade large follicles in the late follicular phase (35% vs. 21%) (OR 2.0; 95% CI 1.1–3.7) and higher clinical pregnancy rate (47% vs. 12%) (OR 6.3; CI 1.1–35.7) compared to Group 2. Conclusion : High grade ovarian PFBF in the EFP during IVF is associated with both high grade PFBF in the late follicular phase and a higher clinical pregnancy rate.     

Comparison of cryopreservation outcome following intracytoplasmic sperm injection and conventional in vitro fertilization

Purpose Our purpose was to compare the success rate of transferring frozen-thawed embryos generated from either intracytoplasmic sperm injection (ICSI) or conventional in vitro fertilization (IVF). Methods A retrospective review of all frozen—thawed embryo transfer (ET) cycles between January 1995 and April 1997 was performed. There were 83 and 204 transfer cycles of frozen — thawed multicellular embryos generated from conventional IVF (group A) and ICSI (group B), respectively. The survival rate of frozen — thawed embryos and the outcome following ET in both groups were assessed. Results The groups did not differ in age (31.7±4.6 and 30.6±6.0; mean±SD) or number of embryos transferred (3.5±1.1 and 3.8±1.3 for groups A and B, respectively). An acceptable pregnancy rate per ET was achieved in both groups, but the rate was significantly higher (P = 0.04) for group A than group B, 32.5 and 20%, respectively. Group A included frozen embryos of a higher quality than those of group B, but the proportion of embryos surviving after thawing was significantly higher for group B than group A (92.5 and 85.6%, respectively; P = 0.0004). The abortion rate did not differ between the two groups: 22 and 26.8% for groups A and B, respectively. Conclusions Although an overall high pregnancy rate was achieved following frozen-thawed ET, it was lower for cycles in which embryos had been generated from ICSI. This difference may be attributed to a lower prefreezing embryo quality in the ICSI group. Embryos originating from ICSI were not vulnerable to cryopreservation and, when implanted, resulted in a comparable abortion rate to thawed embryos of conventional IVF.     

脱氢表雄酮(DHEA)预治疗在体外受精-胚胎移植周期中的应用

目的:探讨脱氢表雄酮(DHEA)预治疗在卵巢储备低下妇女的体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)周期治疗中的作用。方法:对173例卵巢储备功能低下进行IVF/ICSI-ET的患者进行随机对照研究。DHEA预治疗组(n=81)患者口服DHEA,连用3个月,对照组为未服用DHEA预治疗者(n=92)。观察患者的一般情况、超促排卵情况及胚胎发育和妊娠结局。结果:患者一般情况、hCG注射日子宫内膜厚度及E2水平、Gn使用量和Gn使用天数组间均无统计学差异(P>0.05)。DHEA组IVF受精率、优质胚胎率及临床妊娠率均高于对照组(P<0.05)。但在胚胎种植率、早期流产率、周期取消率组间差异无统计学意义(P>0.05)。结论:DHEA预治疗可以改善卵巢储备功能低下妇女的IVF结局。     

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Purpose

This study was designed to evaluate the effects of adding Estradiol (E2) supplementation to progesterone (P) on improvement of pregnancy outcomes in poor responder patients who underwent in vitro fertilization (IVF).

Methods

In a prospective randomized clinical trial, 118 poor responder patients, older than 38 years without contraindications of estradiol consumption from Infertility clinic of a university hospital were randomly divided (by computerized software) into two groups. Control group (59 patients) received only P and intervention group (59 patients) received P and E2 (4 mg/d). Supplementation was done with 4 mg E2 in the luteal phase. Fertilization rate, implantation rate, biochemical and clinical pregnancy rates, abortion rate, ongoing pregnancy, multiple pregnancy and ectopic pregnancy rates were documented for those who completed the study protocol in each group (per protocol analysis) and compared between groups.

Result

Fifty five patients in control group and 53 patients in intervention group successfully completed the study protocol. Treatment outcomes were not significantly different between two groups.

Conclusion

For poor responder women who underwent IVF, addition of E2 to P supplementation could not significantly improve pregnancy outcomes.     

Outcome of conventional IVF and ICSI on sibling oocytes in the case of isolated teratozoospermia

Purpose

To reevaluate the effect of isolated teratozoospermia on IVF and determine if there was any therapeutic benefit to isolated teratozoospermia by ICSI, since there are no widely accepted criteria for the treatment technique about isolated teratozoospermia.

Methods

A total of 441 couples with >20 million and progressive motility >30 % sperm undergoing their first IVF/ICSI cycle were included in the study between 2008 and 2010, for whom at least 8 oocytes were retrived. Isolated teratozoospermia was diagnosed in 183 of the included couples, and the rest couples (normal sperm morphology) were studied as control. Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Fertilization rate, embryo quality, pregnancy rate, implantation rate and spontaneous abortion rate were assessed.

Results

There was no difference in the percentage of eggs fertilized, implantation rate, pregnancy rate and spontaneous abortion rate between conventional IVF and ICSI regardless of the percentage of normal morphology. The day 3 embryonic morphology and rate of development were not different despite the insemination method and percentage of normal morphology.

Conclusion

Because isolated teratozoospermia did not influence the major indices of IVF and the unnecessary use of ICSI is time-consuming, costly and potential risks, couples with isolated teratozoospermia need not be subjected to ICSI.     

Impact of Physician Performing Embryo Transfer on Pregnancy Rates in an Assisted Reproductive Program

Purpose : To evaluate the effect of the individual physician performing embryo transfer, on clinical pregnancy rates. Method : Data from a total of 485 consecutive embryo transfers performed on 485 women aged 23–37 years were prospectively collected for this study. All patients underwent a standard downregulation long protocol for ovarian stimulation. Oocyte recovery was performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups that have been linked to two different ET providers (A and B). The same method of loading embryos into the embryo transfer catheter was used. Results : Clinical pregnancy rates varied significantly (p≤0.01) between the two providers: 36.1% in group A and 20.6% in group B. The number and quality of embryos transferred did not differ between the groups. Conclusion : The results suggest that the physician factor may be an important variable in embryo transfer technique.